Healthcare Provider Details

I. General information

NPI: 1770359051
Provider Name (Legal Business Name): ASHLEY CYNTHIA ESPINOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 NORTH BEAUREGARD STREET, SUITE 250
ALEXANDRIA VA
22311-5879
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW, STE 403
LEESBURG, VA VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-2400
  • Fax: 703-370-7214
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: